Since 2005, more than 1,500 soldiers and Marines have been carried off the battlefield with genital wounds. But since late 2009, when President Barack Obama ordered a "surge'' of 30,000 combat troops into Afghanistan and approved a new tactic of increased foot patrols, the pace of genital injuries has accelerated.

In the year before the surge, 170 combat troops suffered genital wounds, mostly from IED blasts. In 2010, according to Pentagon data, that number leapt to 259. Last year, the Defense Department counted 299 cases of genital wounds that James Jezior, a urologist who does genital repair surgery at Walter Reed, characterizes as "devastating.'' [...]

But for guys like Staff Sgt. Silva whose penises have been partly or totally destroyed, options are few. Expertise within the military on penis replacement, or phalloplasty, is so limited that some Walter Reed patients have been referred to civilian surgeons who specialize in sex-change operations. It's an option not well received in the ranks.